Perspectives – Consumer, Patient, Provider, Payer, Health Plan, Laws and Public Policies 

Perspectives Regarding Systems-Based Practice:  (1) Consumers; (2) Patients; (3) Providers such as physicians, hospitals, others; (4) Payors such as Employer Groups, Government (such as Medicare and Medicaid), and individuals purchasing health care benefits; (5) Health Plans, HMOs, PPOs, Managed Care Organizations (MCOs), Insurers; and (6) Laws and Public Policies encompassing all of the previously listed perspectives.

November 25, 2019:  “Blues band together to challenge bigger rivals,” with subtitle “Plan for national employers targets turf of Aetna, Cigna, UnitedHealthcare,” by Stephanie Goldberg, Crain’s Chicago Business, 1, 24.

A perspective – to consider:

Telehealth – Ethics: Use Common Sense – but what is common? Have empathy – but what does that mean – and can artificial intelligence be trained/taught to have empathy?

“As Telehealth Tech Explodes in Use, Can Medicine Preserve the Human Touch?,” FierceHealthcare, Joanne Finnegan, Heather Landi, March 19, 2019:

According to various media reports, a physician used a video connection to tell 78-year-old Ernest Quintana, he was close to death. He had been hospitalized at a Kaiser Permanente hospital due to progressive lung disease. Per the media reports, the patient’s granddaughter, Annalisia Wilharm, said she was sitting by her grandfather’s bedside in the ICU when hospital staff rolled a machine into the room and a doctor appeared via livestreaming video link and told the patient that no treatment options were left. He died the next day. Wilharm state in media reports that “We knew that we were going to lose him. Our point is the delivery (of the news). There was no compassion.”

Arthur Caplan, Ph.D., founding head of the division of medical ethics at NYU School of Medicine in New York City, said in an interview with FierceHealthcare, “It was a mess – a moral mess”. He said telemedicine certainly has a future, but in circumstances such as the one involving Quintana and his family, common sense should have prevailed.

This is a stark reminder in the medical community of what could be lost in replacing doctors with technology.

Kaiser Permanente issued a statement to correct news media reports that a “robot” delivered the news and the hospital was deeply sorry for falling short of the Quintana family’s expectations. The evening video conversation was a follow-up to earlier in-person physician visits and was not used in the delivery of the initial diagnosis. The hospital used the video connection to provide urgent evening consultation with a specialist physician and a nurse was in the room to accompany the video conversation as is the hospitals standard practice.

Dave Levin, M.D., chief medical officer of Sansoro Health and former CMIO for the Cleveland Clinic, said the situation raises critical questions about the use of technology in patient care. In-person is almost always going to be best.

Medical Ethicists and telehealth experts say it is an opportunity for doctors and hospitals to review how they use telemedicine and decide what kind of information they should communicate by video to guarantee patients the compassionate care they are seeking.

Todd Czartoski, M.D., a practicing neurologist and chief medical technology officer of Providence St. Joseph Health, a Renton, Washington-based health system operating 51 hospitals stated “My immediate thought was, “How does this apply to the 40,000-plus visits that PSJH does virtually every year in our hospitals and clinics?’

Tim Pack, an emergency room physician who co-founded startup, Call9, uses telehealth in nursing homes to provide 24/7 access to palliative care physicians. The company also embeds a paramedic, ENT or nurse in the nursing home to provide in-person care. On average nurse to patient ratios are 1 to 36 and most do not staff on-site physicians. Through telehealth services, remote palliative care physicians provide acute care services and have goal-of-care and end-of-life discussions with patients and family members.